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HACIENDA INC

Intermediate Care Facility, Mentally Retarded

Phoenix, Arizona

Provider NPI: 1417178724

Organization Information:
Organization Name:  HACIENDA INC


Practice Location:
1402 E SOUTH MOUNTAIN AVE  PHOENIX, AZ 85042 US
Tel: 602-243-4231  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
AZLTC0176

Other Provider Identifiers:

IssuerNumberStateType
040064AZ05
ICF001AZ05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




MENTALLY RETARDED NURSING JOBS AZ - Page 1



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